Psychedelics as Medicine? A Look at Alternative Treatments for Mental Health Conditions
Are psychedelics the next “miracle” drug to treat mental health conditions? Recent movements calling for the decriminalization of drugs like psilocybin might suggest that. As mental health management becomes increasingly important in our lives and in claims management, there has been renewed interest in psychedelic drugs. Although psychedelics have no current medical use and are not approved for any mental health treatments, recent research suggests that the drugs may be able to play a positive role in treating various mental health-related ailments. For that purpose, we will outline the current understanding of psychedelics and where they could possibly fit into treatment in the future.
Do Psychedelics Have Potential for Medical Use?
Psychedelics are recognized in the long history of various cultures, many of which ascribed mystic, religious or spiritual significance. In the U.S., a period of counterculture experimentation in the late 1950’s and ‘60’s led to a public perception that the drugs are dangerous and prompted controlling legislation. The U.S. banned the hallucinogen LSD and psilocybin in 1970 under the Controlled Substances Act and assigned Schedule I, flagging them as substances having a high potential for abuse and no accepted medical use. However, similar to how marijuana became decriminalized and then legalized on the state level, some states are considering decriminalizing psychedelics as well. Many psychedelics are botanicals, derived from mushroom, cactus or vine species; more recent compounds are the products of laboratory synthesis. Lysergic Acid Diethylamide (LSD), Psilocybin, Ayahuasca and Dimethyltryptamine (DMT) are among the subjects of recent study that have yielded some encouraging early reports in treatment-resistant depression, addictions, PTSD and “end of life” care that remain to be more fully validated. Psilocybin (or “magic mushrooms”) in particular is the subject of renewed interest. A November 2020 study from Johns Hopkins revealed that two doses of psilocybin, in conjunction with supportive psychotherapy, “produced rapid and large reductions in depressive symptoms, with more participants showing improvement and half of study participants achieving remission through the four-week follow-up.” An additional Johns Hopkins study from 2016 found that treatment with psilocybin along with psychological support “significantly relieved existential anxiety and depression in people with a life-threatening cancer diagnosis. Interestingly, the researchers point out that the effect of treatment with psilocybin was “four times larger than what clinical trials have shown for traditional antidepressants on the market,” suggesting that psilocybin could be more effective in treating mental health issues, especially considering the inconsistent effectiveness of antidepressant medications. Although the study was small, the findings are fascinating: “For the entire group of 24 participants, 67% showed a more than 50% reduction in depression symptoms at the one-week follow-up and 71% at the four-week follow-up. Overall, four weeks post-treatment, 54% of participants were considered in remission – meaning they no longer qualified as being depressed.” A few studies of psychedelics revealed that the drugs have a low likelihood for long-term dependence, addiction or increased mental health treatment. Unfortunately, a full understanding of their pharmacology, safety and effectiveness is limited by the scarcity of sound clinical research. There is still much to learn about the sources, defined constitution of the active product, neurochemistry, dose-response relationships and other critical clinical performance dimensions of psychedelics that would guide their safe and effective use. MDMA, or ecstasy (also a Schedule I drug), has also garnered recent buzz in the news, with people talking about its potential to help with severe PTSD that has not responded to other treatments. A 2019 study of patients with PTSD found that 54% of patients who were treated with MDMA therapy no longer fit the criteria for PTSD two months after the experiment versus 23% in the control group. After a year, that number rose to more than 2/3 of the group. Although these results are promising, there is still little research into the positives and negatives of MDMA use for PTSD or other mental health treatments. As interest continues to build for the potential medical use of psychedelics (and even marijuana for PTSD treatment), we expect studies to continue, hopefully revealing more about their uses and side effects.
Psychedelics, Public Perception, and the Future of Mental Health Treatment
Despite potentially promising results, psychedelics have a long way to travel from their public perception to medical credibility. A visit to “psychedelic” in the dictionary offers a large number of definitions and descriptions, most of which are less related to their use as medicines than to music, art or even fashion design. Visual and auditory hallucinations, intensification of awareness and sensory perception, disorganized thought, loss of coordination, euphoria, anxiety, panic and paranoia are among the reported effects. However, less is understood or discussed about the treatment potential for disorders that remain a challenge to the current pharmacopeia, like clinical depression, persistent anxiety, addiction disorders and PTSD. For now, the potential of better treatments on the horizon is exciting. The ability to treat mental health challenges effectively is vital in the management of workers’ compensation, especially when mental health can have a significant influence on perceptions of pain and recovery. As states continue to consider the benefits and drawbacks of decriminalization, we will keep you updated on changes.